Building a Theory-Based Understanding of Sexual Health Provider Stigma: A Phenomenological Study

Unraveling provider-level sexual health stigma requires building an understanding of contributing factors, such as provider knowledge, values, beliefs, medical training, and other intrapersonal or interpersonal factors that may influence its manifestation at the clinic level during patient–provider interactions. Healthcare provider stigma has not been sufficiently understood or explained using classic psychological theories, such as Cognitive Dissonance Theory (CDT) or Social Cognitive Theory (SCT). We build a theory-based understanding of sexual health-provider stigma by proposing modifications to the SCT to develop the Modified SCT (M-SCT) model, where cognitive dissonance is hypothesized to influence the personal/cognitive and behavioral factors of the M-SCT. Employing a phenomenological study design, we administered a semistructured interview guide, which included two vignettes, to 10 sexual healthcare providers. We conducted an interpretive phenomenological analysis, in which initial codes were organized into overarching themes and then categorized according to constructs of the M-SCT. Results revealed themes within the behavioral and social/environmental factors of the M-SCT and several social, cultural, and political factors that intersect among all three factors of the SCT as part of overall reciprocal determinism. Key themes highlighted factors that contribute to patient–provider stigma: provider cultural humility and ability to tolerate imperfection; using affirmative language; the impact of patient internalized shame/stigma; patient past experiences with other providers; paternalism in medicine; and clinical practices, culture, and values. While these theoretical frameworks helped illuminate these themes, additional research is needed to explore how provider cognition is shaped by factors not assessed at the intrapersonal and interpersonal levels.